Wednesday

Norcross said the goal was to shine a spotlight on the issue with real life stories about how the high costs of prescription drugs is impacting everyday Americans and their health care.

PENNSAUKEN — Cheryl Dunican Hein is all too familiar with the Medicare “doughnut hole” and what it means to her finances.

The Maple Shade resident already takes a half dose of one of her prescription medications in order to try to reduce the $400 a month expense of the drug, which has no generic form.

Julie Terrell has a similar problem. Her 10-year-old daughter requires a specialty drug to stave off debilitating seizures because of the genetic Sturge-Weber syndrome, but her family’s prescription drug plan specifies “generics preferred,” which she has learned means her family will have to pay extra just to keep her daughter out of a hospital.

“It’s about $893 a month plus a $40 co-pay,” said the Sicklerville mom.

Meanwhile, Jane Leichner, of Haddon Township, has used the same medicated ointment to treat cold sores for years. But while the drug is exactly the same, she says the price for a small 5-gram tube has steadily risen so that it now runs $978.

Their stories aren’t special cases. In fact, they’re all too common, according to Mark Taylor, president of the New Jersey Pharmacists Association.

“We (pharmacists) hear this every single hour of every single day,” he said Wednesday morning during a roundtable discussion with the three women and Rep. Donald Norcross, D-1st of Camden.

Pennsauken Mayor Jack Killion and Dr. Jubril Oyeyemi, a Mount Holly internist affiliated with Virtua Health, also participated in the talk, which was held at the Pennsauken Towers senior apartments complex and broadcast on the congressman’s Facebook page.

Norcross said the goal was to shine a spotlight on the issue with real life stories about how the high costs of prescription drugs is impacting everyday Americans and their health care.

“We do know the out-of-pocket expenses, the access to the medication, not having generics, it’s a burden,” Norcross said, citing patients who have had to choose between purchasing prescriptions and eating and those who have been forced to cut doses in order to reduce their expenses.

“All these things end up having an impact on a patients’ health outcomes,” the congressman said.

Much of the talk surrounded the anecdotes from Dunican Hein, Leichner and the Terrells.

Dunican Hein described the so-called doughnut hole in Medicare Part D prescription plans, which is a coverage gap patients hit when their prescription drug costs reach a threshold. Once that occurs, patients must pay close to the full price for their medications until their out-of-pocket costs reach a “catastrophic level” and full coverage returns.

“The more drugs you’re on, the faster you get into the doughnut hole and the more you spend,” she said.

Oyeyemi said studies show three out of four patients fail to follow their doctor’s instructions for taking prescriptions, most often because of the cost.

“The No. 1 reason people end up back in hospitals is because of not properly taking their medications,” Oyeyemi said, citing a patient he saw in an emergency room who suffered a heart attack previously but was not taking any medication for her condition because of the expense.

Terrell described how her family’s insurance initially required them to pay $893 a month for a specialty drug for her daughter, plus a $40 co-pay. Her family went through five appeals before the insurer agreed to lower their costs, but she said the drug is still expensive and is just one of three her daughters needs.

“A $1,000 a month. That’s a mortgage payment. That’s a car payment,” she said, adding that without the medications her daughter would likely wind up in a hospital at a cost of $20,000 a night.

“Something’s not right with the system,” Terrell said. “If this is happening to me, it’s happening to everybody,”

Taylor said that medication for common ailments can be expensive if not covered by a prescription plan and that specialty drugs can cost as much as $50,000 a month.

“We battle to try to get these covered but even the co-pays are out of reach. They can run hundreds of dollars and thousands of dollars,” he said.

Taylor placed much of the blame for rising costs on pharmacy benefit managers — middlemen who negotiate drug purchases for insurers and large buyers. While these PBMs are intended to reduce costs, Taylor said the negotiated savings are often being pocketed by these middlemen rather than passed on to the consumers. In some cases, their actions are actually driving up costs and many contracts between pharmacies and PBMs forbid pharmacists from informing customers of cheaper alternatives, a practice known as “pharmacy gag clauses.”

“We were barred from explaining to patients how they can save money,” he said.

Another problem discussed at the round table was how pharmaceutical companies manage to delay when brand drugs can be reproduced as generics. One tactic is to pay generic companies not to reproduce their version in order to keep the price high. Another tactic is to make slight changes to a drug and rebrand it when a patent is close to expiring.

Norcross said pharmaceutical companies are a key industry in New Jersey, but he said some of their business practices are now impeding the delivery of adequate health care.

“It has turned into a money-making machine, a commodities market,” he said.

Norcross said he doesn't see one "silver bullet" solution. Instead, he said multiple steps are needed to boost price transparency, increase the availability of generic drugs, spur competition and improve access to health insurance. He expects several related bills will be taken up by Congress this year, including legislation to allow Medicare to negotiate reduced drug prices, but he also said pharmaceutical companies are lobbying hard to prevent them from ultimately becoming law.

"The biggest increase in lobbying is from pharmaceuticals," he said. "But we'll keep fighting."

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